Appendix 8.  Recommendations of Other Groups

The Centers for Disease Control and Prevention (CDC) updated its lead screening recommendations in 1997 in response to evidence of inadequate screening of children at high risk, and to concerns regarding appropriate use of limited resources in low prevalence communities. The revised CDC guidelines provided state public health entities with authority and guidance to develop state and local policies for childhood lead screening. The CDC recommended universal screening in communities without data regarding the prevalence of elevated blood lead levels adequate for local policy development, and in communities where >27% of the housing was built before 1950. Screening of all children receiving Medicaid, Supplemental Food Program for Women, Infants and Children (WIC) or other governmental assistance, and in populations where  >12% of children ages one-two years have elevated blood lead levels was also recommended. Targeted screening is recommended for all other children based on individual risk assessment.¹⁹ This approach is also supported by the American College of Preventive Medicine.¹⁰⁰

In 1998, the American Academy of Pediatrics (AAP) recommended that pediatricians:

1. Provide anticipatory guidance to parents of all infants and children regarding potential risk factors and specific prevention strategies tailored for the family and community.
2. In conjunction with public health authorities, develop and use community-specific risk assessment questionnaires to guide targeted screening in communities where universal screening is not appropriate.
3. Provide lead screening at age 9-12 months and consider again at approximately 24 months following state health department guidelines utilizing individualized targeted or  universal screening as recommended.
4. Assess possible lead exposure periodically between six months and six years of age using community-specific risk assessment questionnaires. Blood lead testing should be considered in children with a history of abuse, neglect, or conditions associated with increased lead exposure.
5. Actively participate in state and local lead poisoning prevention activities.

Recommendations by the AAP regarding the urgency and extent of followup differ slightly from those of the CDC and depend on the risk classification and on confirmed venous blood lead levels.¹⁰¹  The 1998 Recommendation was recently updated to include recent data regarding the prevalence and adverse effects of lead exposure, and to provide recommendations for pediatricians and government policymakers.¹⁰²

The American Academy of Family Physicians (AAFP) recommends lead screening at 12 months of age in infants who have the following risk factors: residence in a community with a high or undefined prevalence of lead levels requiring intervention, residence in or frequent visits to a home built before 1950 that has dilapidated paint or has recently undergone or is undergoing renovation or remodeling, close contact to a person who has an elevated blood lead level, residence near a lead industry or heavy traffic, residence with a person whose hobby or job involves lead exposure, use of lead-based pottery, or use of traditional remedies that contain lead.¹⁰³

Medicaid's Early and Periodic Screening, Diagnostic, and Treatment Program requires that all children be considered at risk and must be screened for lead poisoning. CMS requires that all children receive a screening blood lead test at 12 months and 24 months of age. Children between the ages of 36 months and 72 months of age must receive a screening blood lead test if they have not been previously screened for lead poisoning. At this time, states may not adopt a statewide plan for screening children for lead poisoning that does not require lead screening for all Medicaid-eligible children.^4,104

Studies of provider behavior before and after the 1997 Revision of the CDC Recommendations demonstrate that blood lead screening and followup of children is often inadequate.^105,106

Recently, the CDC Advisory Committee on Childhood Lead Poisoning Prevention (ACCLPP) reaffirmed its support for state and local decision-making based on local data and conditions regarding the appropriate lead screening recommendations. The ACCLPP also acknowledged the limitations of screening and other forms of secondary prevention, and advocated a increased local and national focus on housing-based primary prevention of lead exposure.²¹

No national organizations currently recommend screening pregnant women for elevated lead levels.  Some state organizations have developed local policies regarding lead screening. In 1995, the New York State Department of Health and American College of Obstetricians and Gynecologists District II developed lead poisoning prevention guidelines that mandate anticipatory guidance for pregnant women, risk assessment, and risk reduction counseling and childhood lead poisoning prevention education.¹⁰⁷

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